Involving patients in medicines optimisation in general practice: a development study of the “PREparing Patients for Active Involvement in medication Review” (PREPAIR) tool

Background Many patients have multiple health conditions and take multiple medications (polypharmacy). Active patient involvement may improve treatment outcomes and ensure patient-centred care. Yet, patient involvement remains a challenge in clinical practice. We aimed to develop and pilot test a questionnaire-based preparation and dialogue tool, the PREparing Patients for Active Involvement in medication Review (PREPAIR) tool, to encourage the involvement of patients with polypharmacy in medicines optimisation in general practice. Methods We conducted a literature review followed by a co-production process to develop the tool: a workshop with six GPs and pilot testing, including observations and interviews, with 22 patients, three GPs and three practice staff. During this process, we made continuous adaptations to the prototype. We analysed the qualitative data thematically, focusing on the development process and mechanisms of impact. Findings The final PREPAIR tool included five items concerning the patient’s experience of 1) adverse drug reactions, 2) excess medication, 3) unnecessary medication, 4) medication satisfaction and 5) medication-related topics to discuss with the GP (open-ended question). The applied workflow during testing was as follows; the patient completed the PREPAIR tool at home, to encourage reflection on the medication, and brought it to the GP consultation. During the consultation, the GP and the patient reviewed the patient’s responses and discussed potential medication-related problems. For some patients, the increased reflection led to worries about the medications. Still, the pilot testing showed that, when using the PREPAIR tool, the patients arrived at the clinic well prepared and empowered to speak. From the PREPAIR-supported dialogue, the GPs obtained a better understanding of patients’ perspectives and provided a more patient-centred consultation. For the patients, the PREPAIR-supported dialogue ultimately promoted an increased sense of security, satisfaction and insight into their medication, despite initial worries for some patients. Conclusions We developed a brief tool to support active patient involvement in medication review in general practice. The PREPAIR-tool was well received by both patients and GPs and fitted well into the existing clinical practice. Our findings suggest that the PREPAIR-tool can support patient involvement during consultations and facilitate patient-centred care. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01733-8.

In the first condensation made by AS and AM, the list of potential questions were reduced to 79 items, still covering 36 themes. This list was then considered by the entire research group, who further condensed the list of questions to 22 items covering the following six themes: personal information, experiences with medicine, concerns about medicine, difficulties related to medicine, needs of aid related to medicine and wishes for treatment (details presented in table 1).

Phase 2: Workshop with GPs
During the workshop, the participants discussed the list of potential themes and items and rated them by their ability to enable prosperous dialogue with patients. The number of questions was reduced as the GPs preferred a concise and brief questionnaire. Based on their discussions and perspectives, the research group adjusted the questionnaire and reduced the number of items to five, which were culturally translated into Danish, and the exact wording was selected. Based on the existing literature, the research group decided on the response options and scales before initiating the first pilot test. Pilot testing the prototype Phase 3: First pilot testing During the first pilot testing, the questionnaire was continuously revised as the pilot testing was designed and conducted in a stepped process. Based on the patients' experiences with filling out the questionnaire, the response scale was simplified, and instructions were added. The response scale was changed from a five-point Likert scale ('highly agree', 'agree' 'neither agree nor disagree', 'disagree' and 'highly disagree') to a three-point Likert scale ('agree', 'neutral' and 'disagree').

Phase 4: Second pilot testing
During the second pilot testing, the order of the questions was changed into starting with the questions that the patients found easiest to answer. The font type and size was changed, as some patients were visually impaired and found it hard to read the questions in the original layout.  Changing the order of the questions. Graphic setup of questionnaire.

Format after phase
List of five questions Response scale to a three-point Likert scale (agree, neutral, disagree).

List of five questions
Response scale to a three-point Likert scale (agree, neutral, disagree).

Content after phase
You will soon visit your GP and talk about your medication. Completing this form will help you prepare for the conversation. At the same time, you will help your GP select the best treatment for you. Please bring the questionnaire at the next appointment with your doctor. Do you mostly agree or disagree in the following statements?
• I am overall satisfied with my current medication • I sometimes think that I get too much medication.
• I experience adverse drug reactions of the medication that bother me significantly. • I think that I might get some medication that I do not need. • Is there something about your medication that you would like to discuss with the GP? Yes/No. If yes, please elaborate.
You will soon visit your GP and talk about your medication. Completing this form will help you prepare for the conversation. At the same time, you will help your GP select the best treatment for you. Please bring the questionnaire at the next appointment with your doctor.
Do you mostly agree or disagree in the following statements?
• I experience adverse drug reactions of the medication that bother me significantly. • I sometimes think that I get too much medication.
• I think that I might get some medication that I do not need. • I am overall satisfied with my current medication • Is there something about your medication that you would like to discuss with the GP? Yes/No. If yes, please elaborate.